Migraine vs Sinus Migraine: How To Identify the Difference
- David S. Klein, MD FACA FACPM
- Aug 26
- 4 min read
Understanding migraine vs. sinus headache matters because the right diagnosis drives the right treatment. Below is a clear, patient-friendly guide to tell them apart and get you closer to effective relief.
What Are Migraines?
A migraine is a neurological disorder marked by moderate to severe throbbing or pulsating head pain, often on one side, commonly accompanied by nausea and sensitivity to light and sound. Some people experience a visual or sensory "aura" before or during the attack.
Common Symptoms of Migraine vs Sinus Headache, Also Called a Sinus Migraine
Typical migraine signs include throbbing pain (often unilateral), nausea and/or vomiting, photophobia (light sensitivity), and phonophobia (sound sensitivity). Nasal symptoms like a runny or stuffy nose and tearing can occur with migraine and are a major reason it's mistaken for a sinus problem.
Causes and Triggers: Where "Sinus Migraine" Confusion Starts
Common migraine triggers include stress, dehydration, sleep changes, skipped meals, certain foods, and hormonal fluctuations. These triggers can overlap with allergy season or a lingering cold when nasal symptoms are also common.
Who Is at Risk?
Migraines can affect anyone, but women are about three times more likely than men to experience them. Family history and certain co-existing conditions (like anxiety, depression, and sleep disorders) also raise risk.
What Are Sinus Headaches?
True sinus headaches happen when the lining of the sinus cavities is inflamed (sinusitis), creating pressure and pain in the face and forehead. Because both conditions can involve facial pain and nasal symptoms, sinus headache vs migraine can be tricky to untangle without a careful exam.
Common Symptoms of Sinus Headache vs Migraine
Sinusitis typically causes facial pressure or fullness (cheeks, forehead, between/behind the eyes), nasal congestion and discharge, postnasal drip, tooth pain, possible fever, and pain that worsens when you bend forward. These features are different from migraine's hallmark nausea and sensory sensitivities.
Underlying Causes (Allergy, Infection, Structure)
Sinus inflammation can stem from viral infections, bacterial infections, allergies, or structural issues like a deviated septum or polyps. Managing allergies and nasal inflammation is often key to reducing sinus-related headaches.
How Sinus Headaches Are Diagnosed
A clinician can often diagnose sinusitis by history and exam; in some cases, nasal endoscopy or CT imaging is used - particularly for chronic or recurrent cases or when complications are suspected. Routine imaging is not recommended for uncomplicated acute sinusitis.
Key Differences Between Migraine vs Sinus Headache
Pain Location and Type
Migraine: Pulsing/throbbing pain, often on one side; may spread; worsens with activity.
Sinus headache: Pressure-like, deep, constant pain over the cheeks, forehead, or bridge of the nose, often with tenderness.
Accompanying Symptoms (Nausea, Congestion, Sensitivity)
Migraine: Nausea/vomiting; light and sound sensitivity; may include aura; nasal tearing/runny nose can occur.
Sinus headache: Thick nasal discharge, congestion, postnasal drip, possible fever, reduced smell.
Duration and Frequency
Migraine: Individual attacks often last 4-72 hours.
Sinusitis-related headache: Often persists for a week to 10 days or longer, tracking the course of the infection/inflammation.
Why Misdiagnosis Is Common
Migraines can trigger autonomic nasal symptoms (runny/stuffy nose, watery eyes), so it can feel like a "sinus migraine." Because both conditions can follow a cold or seasonal allergies, people (and even clinicians without a full history) may lean toward sinusitis. The American Migraine Foundation notes that about 90% of self-diagnosed sinus headaches are actually migraines.
How to Get an Accurate Diagnosis
Importance of Medical Evaluation
If you frequently get "sinus" pain plus nausea or light/sound sensitivity - or if over-the-counter decongestants never seem to help-ask your clinician to consider migraine vs sinus headache. A targeted history (triggers, family history, aura, disability level) and focused exam are usually enough to distinguish the two.
Role of Imaging and Testing
For uncomplicated acute sinusitis, routine imaging isn't recommended; clinicians reserve CT or endoscopy for recurrent/chronic cases, atypical features, or suspected complications. Conversely, most people with stable, typical migraine don't need brain imaging.
Treatment Options: Sinus Headache vs Migraine
Treatments for Migraines
Acute relief: NSAIDs or acetaminophen at onset; prescription triptans; some may use gepants (CGRP receptor antagonists) or ditans under clinician guidance. Ditans and gepants are new migraine treatments that differ slightly from existing therapies. These new medications provide additional options for people with migraine for whom other medications may be at risk of side effects.
Preventive options: CGRP monoclonal antibodies, beta-blockers, topiramate, certain antidepressants, and onabotulinumtoxinA (Botox) for chronic migraine.
Lifestyle support: Sleep regularity, hydration, stress management, trigger tracking.
Treatments for Sinus Headaches
Self-care & symptom relief: Nasal saline irrigation, intranasal corticosteroid sprays, humidification, and cautious short-term use of decongestant sprays (avoid more than 3-5 days).
When antibiotics help: Many acute sinus infections are viral and resolve on their own; clinicians may consider antibiotics for uncomplicated acute bacterial sinusitis after watchful waiting or when specific criteria are met.
Chronic or recurrent cases: Evaluate for allergies or structural contributors; ENT referral and, rarely, surgery may be considered.
When to See a Specialist (Headache or Sinus Care)
Your "sinus headaches" come with nausea/vomiting or light/sound sensitivity.
Headaches last 4-72 hours and keep returning despite "sinus" treatments.
You have chronic congestion, facial pain, or infections that persist beyond 10-14 days or keep recurring.
Any red flags (sudden "worst headache," new neurological symptoms, stiff neck, high fever, vision changes) require urgent care.
If you're tired of guessing between sinus headache vs migraine, our team can help you pin down the cause and build a plan that works-whether that means modern migraine care, targeted sinus treatment, or both. Schedule a thorough evaluation at the Stages of Life Medical Institute.
